Increases in HDL Cholesterol May Be Tied to Improved Psychotic Symptoms
By Lorraine L. Janeczko
NEW YORK—In patients with first-episode psychosis (FEP), an increase in serum high-density lipoprotein (HDL) levels during antipsychotic treatment is linked with improved negative FEP symptoms, new research from Norway suggests.
"With a sample of non-affective FEP patients, the authors tracked lipids and symptoms over a 12-month period. Controlling for age, gender and pattern of antipsychotic use, they reported that increases in HDL were associated with a reduction in negative symptoms: problems with motivation, affect, sociality. They found no associations between lipids, positive symptoms (delusions and hallucinations) or body mass index (BMI)," Dr. Raymond Cho of Baylor College of Medicine in Houston, Texas, told Reuters Health by email.
"This finding could point to interesting mechanistic links between lipid metabolism and psychotic symptoms and would be consistent with prior reports of increases in weight, triglycerides or total cholesterol correlating with symptom improvements," added Dr. Cho, who was not involved in the study.
Lead author Dr. Pryanthi B. Gjerde of the University of Bergen, in Norway, and colleagues prospectively studied 132 non-affective antipsychotic-treated patients (ages 18-65) with FEP who were involved in the Norwegian Thematically Organized Psychosis (TOP) project. The findings were reported online November 9 in Schizophrenia Research.
At baseline and at 12 months, the researchers collected data on antipsychotic use, clinical state, BMI, and serum lipids: total cholesterol, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychotic symptoms.
The researchers used a mixed-effects model to adjust for smoking, alcohol use, and education as emblematic of potential lifestyle confounders.
An HDL increase during a one-year period of antipsychotic treatment was linked with a statistically significant reduction in PANSS negative subscores, even if BMI changed. Associations between serum lipids, BMI, and PANSS scores were not significant.
Dr. Dolores Malaspina, of the Icahn School of Medicine at Mount Sinai in New York City, said in an email, "It is of interest that increasing HDL levels predicted an improved outcome in schizophrenia. Similar effects include findings that lower HDL predicts a worse outcome in depression and is associated with suicidal behavior."
"As these lipids are involved in the pathways for neurosteroid production, this finding may shine a light on the importance of neurosteroids for schizophrenia treatment, which are important neural modulators," added Dr. Malaspina, who was not involved in the study.
Dr. Cho, however, pointed out that the findings “are potentially compromised by a statistical confound called regression to the mean, which refers to the fact that, with a completely random distribution of values, the extreme baseline values will tend to be associated with less extreme values at follow-up, completely by chance. Thus, one might incorrectly infer that such changes over time that are occurring randomly are due to some causal factor being examined (in this case, HDL changes being causally related to negative symptom changes)."
Dr. Cho advised caution in inferring a causal link between HDL cholesterol and negative psychosis symptoms until the findings are replicated in a more statistically sound, precisely controlled study.
In their article, the authors call for more sufficiently powered longitudinal studies in drug-naive patients to explore the relationship between lipid pathways and psychosis.
The study’s corresponding author did not respond to requests for comment.
SOURCE: https://bit.ly/2zPYaeL
Schizophr Res 2017.
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